Colorado — Photo by Alberto Restivo

Guess who’s back again? The 5Q — Startup Lifecycle: A Chat with Patrick Leonard

‘round the outside, ‘round the outside, ‘round the outside — Guess who’s back, back again

In the 5Q, Tincture sits down with leaders to discuss their day to day work and share their perspectives on healthcare, medicine, and progress.

Patrick Leonard is a Denver-based technologist and entrepreneur who’s operated at the forefront of digital health for most of the last decade. He was the Chief Technology Officer on the founding team of iTriage, served as Vice President of consumer technology at Aetna, and recently founded Listen.MD.

1. Can you tell us a little bit about your background and journey into the healthcare industry?

Well — my journey started as a kid. I was 10 years, my parents got us an Apple II, and it changed my life. I loved building stuff. I was part of that first generation of of web developers who moved to the Bay Area in the mid 90’s during the dot com boom. I spent the first half of my career in various industries — consulting, technology, finance, with a mix of experiences at big companies and startups.

It’s been almost a decade since I’ve been working in healthcare. Initially I kind of fell into the industry, through one of the companies I was working with — though I should add my wife has also been in the healthcare industry for a long time, and her work really inspired me.

As far as this last chapter — I had just gotten into mobile development, mostly building corporate facing mobile apps, when the first iPhone came out. I was introduced to two physicians in Denver who were looking for someone to come in and build a mobile technology platform. That turned into iTriage — which has now been used by more than 20 million people and has a 4.5 star rating in the App store. We sold the company to Aetna a few years back and I stayed on as CTO for several years.

2. Tell us about your new venture, Listen.MD

Over the past year, I had the chance to look back. I felt the combination of mobile, consumer, healthcare at iTriage had been a really meaningful journey. As I started to contemplate what was next, my wife and I had our second daughter. I saw my wife going through all of these appointments with physicians, pediatricians, and so on, holding a baby in one hand while trying to establish clear communication with the doctor, to learn what she needed to know. I saw that the point of care is such a challenging piece of the puzzle.

I began talking with Dr. John Froelich — who became my co-founder at Listen.MD — about how challenging the provider’s side of that conversation is. These highly trained medical professionals are spending 50 percent of their time doing data entry, and less than 30 percent of their time seeing patients. Many doctors spend time at home at night finishing their documentation when they’d rather be with their family. Half of doctors are experiencing professional burnout and many are leaving medicine.

So, at Listen.MD we built the first “Digital Scribe.” It’s a voice-driven, mobile-enabled approach to capture and understand what the provider says to the patient. It can understand the context, and it generates a visit note for physicians so they can be done before they leave the room.

It’s hard to believe that there is still some nostalgia for paper records — but it’s not because providers don’t see the value in technology for things like a longitudinal patient record. They are mostly scientists by training — they get all of that — but doctors miss paper records because they were simpler, they were not obtrusive, and they made it so much easier to talk to patients. Most doctors can’t afford to hire medical scribes to sit and take notes.

Electronic Health Records systems were designed as billing systems — we saw a gap in the market for tools that support rather than disrupt clinical workflow. Changing the user experience to be voice and mobile to get away from the desktop and keyboard. Using machine learning techniques to dramatically save time. Integrating with the EHR to make it all seamless. We’ve been focused on understanding the physician user experience, listening to physicians, nurses, PA’s, and asking what they’d want in an ideal world. And they’re just saying that they simply want to be able to talk to their patients, make eye contact, to use their hands, to be engaged in the conversation.

3. You’ve built mobile apps for both consumers and for physicians. Can you compare and contrast these experiences?

The main thing is that, with consumer apps there’s a much more diverse set of users to think about. So — you have to approach problem a little differently. You have to figure out how do you pick a starting point, survey them, collect data, understand the customer. On both sides there’s a lot of discipline involved in selecting who to go after to start, but with consumers is a much broader group.

Now we’re focused on providers — physicians, nurses, Physician Assistants (PAs), and so on. With physician apps, in some ways the bar is higher — especially in the area of content quality, accuracy, those sorts of things. You have to be able to hang your hat on that. Is what you’re doing highly effective, and highly accurate? Can you prove it?

Generally, that’s the difference between digital health apps and mobile apps in other industries. The line for minimum viable product (MVP) is a far brighter line in digital health. You have to clear a real threshold of quality and accuracy, which in turn has implications for how you structure the business, how much capital you raise, all of it.

4. What advice would you have for entrepreneurs whose products have been newly acquired? What is the most challenging thing about working inside of a startup after your company has been acquired? How does your role change working inside of a corporation?

Well it depends very much on the specific situation. But in general, I’d say that to the extent possible, when going through the planning phase of the acquisition it’s critical to set clear expectations for what the structure is going to be afterwards. What does the governance look like? What is the mission for the startup post acquisition, and how does fit in with the parent company. Is it a standalone business unit inside of the company, or is it blended in? Just being really clear up front and managing expectations proactively, for both sides, is critical so the team understands what the new environment will look like. That’s key to keeping people around and getting them invested in the new strategy.

5. Aetna recently made the headlines when they announced a partnership with Apple. Based on your insight and your experiences there, what are your thoughts on this new deal — What constitutes a “success” in a deal like this one?

I think that partnership is really interesting. There are a few different pieces to it: the Apple watch and developing the applications. I think on the Apple watch side of thing for employees, you have to look at Aetna’s role as an employer more than as a payer. They want a healthy workforce, they want to be able to promote and measure that.

On the application side — Aetna has really been pushing to be an innovative player in healthcare. They’ve been pushing innovation at the senior leadership level, starting from Mark Bertolini, in the strategy and the thinking behind this for several years. iTriage is one example — when we were in early talks with them, it was clear they wanted to help drive healthcare consumerism in the US. They had the vision for digital health then, and they’ve been working on it ever since.

So, I think this relationship is better viewed through that lens: It’s one more step towards a longer term vision.

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